MANAGING CULTURAL DIVERSITY IN HOSPITAL SYSTEMS IN THE ERA OF COVID-19

Uche Nwabueze, Professor, Maritime Administration, Texas A&M University

For hospital systems to compete effectively in the global market place, to serve patients and to sustain medical success, all hospitals must become as diverse as the market it is trying to reach and serve. In financial planning most financial consultants preach the necessity of a diverse financial portfolio, but the same ad vocation is not made when it comes to hiring people in the workplace. What you find is a corporate landscape of ignorance and indifference to the benefits of a diverse workforce. In most organisations, diversity at the lower inhuman levels rather than at middle to senior managerial positions is the norm. This tendency seems to suggest that excellent organisations are defined by the homogeneity of management. However, I have found the reverse to be the case. Great organisations in my opinion should be environments where gender, ethnic, race, and spiritual differences are respected — a culture of social inclusion and integration. Top management should be heterogeneous in composition. This paper suggests that hospital organisations that are serious about achieving success in the provision of care and caring for patients and, as a result increase market share must embrace the opportunities cultural diversity offers. The paper offers a plan to make cultural diversity work better in hospital systems.

In an increasingly diverse world, hospital systems must be fundamentally aware of cultural differences and strategise ways to overcome challenges posed by the lack of people integration and respect of cultural differences, and appreciate that the “melting-pot” era is over. However, in the workplace there still exists racism, discriminatory hiring and promotion policies personal and managerial behaviour based on perception of what reality is and not on reality itself. Thus, the reality is organisational situations where career progression and development is defined absolutely by the colour of your skin. In spite of some progress by some hospital systems to embrace diversity, global diversity initiatives at best is a failure.

What is diversity?

The author is of the view that diversity represents a highly integrated work environment where the children of the world come together in fulfilment of a common, meaningful purpose. By children of the world, the author posits a representation of Women, Gays, Lesbians, Asians, Latinos, Blacks, Whites, etc. — that is people of all races, gender, religion and ethnic background. The ado vacation is an organisational family unit that prohibits discrimination. Diversity therefore calls for an open, honest, harmonious and inclusive environment where people are treated with respect and dignity –an equivalent of the United Nations.

Be it as it may, a reality check of true diversity in the workplace is inclusiveness and togetherness — how open-minded are people in forming relationships. Or do we gravitate towards colleagues who are similar in gender and color characteristics; does management treat everyone equally regardless of race? How conflicts between two individuals from different cultures are resolve? It is author’s suggestion that winning hospital systems of the future would resemble a league of nation of highly valued, highly involved, highly engaged, highly rewarded, and highly appreciated people who often times agree to disagree, but are united in their quest to win in the market-place by providing extraordinary medical service. This would require the development of an organisational character strengthened by cultural differences. However, top management of organisations must have the courage to prevent cultural homogeneity and opt in favour of cultural heterogeneity that is a culture of social inclusiveness. The most effective way to achieve this is through conversation; helping people to confront their underlying assumptions and beliefs of minorities (Women, Gays, Lesbians, Blacks, Latinos, Asians, Jews and Muslims).

Assumptions and beliefs

The assumptions and beliefs that we hold of people that do not look and act like us, has a lot to do with upbringing. I believe that a child’s behaviour reflects the manner in which he or she is raised. If she is raised with love, she becomes loving; if she is raised with hate; she becomes cruel and spiteful. Furthermore, if a child is raised in an all white suburban area, attended all white schools and had all white friends that child comes to accept that as the social norm and have little or no understanding of differences in the social composition of the workplace. It therefore becomes very difficult to socialise into a system that suddenly has a group composition of Blacks, Asians, Latinos, Gays etc, people you have nothing in common with. Most do not even speak like you and have never had similar vacations or watch the same TV shows and all of a sudden they are colleagues at work.

Moreover, you heard at history classes in high school and at home that blacks are only good in music and athletics, and are not predisposed to rules and responsibility. In fact, your parents may have suggested that Blacks are meant to be inarticulate and lazy; Hispanics are strong-headed, un-educated, and only useful in menial jobs; Asians are conniving and cannot be trusted; Gays are sinners and must not be tolerated and women are supposed to be at home tending to the kitchen and children - necessary evils. To confront our ignorance to differences in culture, to gender and to sexuality, management must help employees change the internal pictures – the mental model that impacts their relationship with others. We, either as managers or employees, must realise that our mental models are not fixed truths, but temporary, wrong assumptions and learn through training and mentoring programs that people should be taken for who they are. This requires the need for each of us to have a fundamental understanding of our inner-most self, of our purpose in life and develop the strength of character to challenge our assumptions and beliefs, only then can we find inner peace- a requirement for building an emotional connection to other people.

Addressing people Issues in hospital systems

A cross-mentoring programme is important in overcoming childhoodbased belief systems. I am against mentoring programmes based on White/White; Black/Black; Woman/Woman etc. They are divisive and do not encourage understanding, building bridges based on integration and oneness. If hospitals believe that hiring a token Black, Latino, Asian, Gay, or Woman is what diversity represents, they need to rethink. In ensuring that mentoring programs work there must be a spirited effort at desegregating middle and upper levels of the organisational hierarchy. A change in people’s behaviour and attitude is also required. For example, most women believe that their case is about untapped potential, the expectation of them by management to assimilate by becoming one of the boys. Thus, management has to remove all gender-based hurdles to women and other protected class career progression and development.

For other minority workers, management must emerge from its blissful ignorance and realise that diversity is not affirmative action. My understanding of affirmative action in the American context is amusing; wherever there is a minority worker, he or she is assumed by white colleagues to be less qualified. This assumption is not representative of the true situation in most industries. In higher education for example, most minority faculty members are terminally degreed (Ph.Ds) and in healthcare, minority staff members are often over qualified and yet hold lower level positions.

Furthermore, they face the daily challenge of having to prove themselves to colleagues and patients, and would have to work four times as hard to gain credibility and acceptance. It becomes painful to come to the reality that for the minority worker the issue of respect, acceptance, status, belongingness and recognition is wishful thinking. Another key challenge for management is having the courage to focus on equality of opportunity- a process of affirming talent, drive and merit. For example, Ann Compton who many regard as one of the finest ABC news reporters was one of the very first women to be hired by ABC Corporation. At the time of her interview, Anne Compton was not more qualified than the male candidates, but the organisation chose to give her the opportunity to serve and the rest is history. According to Sam Donaldson a colleague of Ms Compton; diversity is not affirmative action, but a process of creating out of the box thinking, which is only tenable in a culturally rich work environment (Personal Communication, 2005).

In addition, Barbara Walters was discriminated against because it was suggested that she had a pronunciation problem with ‘r’, which was interpreted as she having a Brooklyn accent. Ms. Walters was later given the opportunity and today she is a television legend.

The suggestion is for organisations’ to give the so called B and C players the opportunity to serve alongside the so called A players. Management must therefore eliminate internal cultures that ignore great ideas from the minority worker, perceives assertiveness as aggression; perceives a questioning mind as insubordination and destroys souls through destructive comments rather than enhancing the mind, heart and spirit of the wholeness of the individual regardless of cultural differences.

Diversity as a competitive weapon

It is claimed by most writers (Thomas and Ely, 2000) that a diverse workforce is a factor for competitive advantage. However, Thomas and Ely contend that the poor application of both assimilation and differentiation models of diversity have hindered the value of a diverse workforce. In the assimilation model, Thomas and Ely claim that the mistake that management makes is the tendency to treat ‘everyone’ the same by blending minorities into a majority monoculture. Whilst in using the differentiation model, organisations tend to pigeonhole employees into niche jobs and markets based on their background. For example, blacks are hired and assigned to promote products designed for the black market. Whatever, the model used; the real issue is the failure of management to conceive of how best to utilise a heterogeneous workforce. It is my opinion that the failure of most healthcare systems to adequately address implicit bias in the recruitment and hiring process continue to negatively impact non-whites.

A diverse workforce I believe has great potential as a source of competitive advantage only if the socialisation, assimilation, training, social recognition, responsibility, career development and achievement are accorded minority workers. More fundamental is the need to listen to them and facilitate an environment where their attitude is moved from a passive to effective role and from trying to survive to a partnering role. (Figure 1).

The real environment of most hospitals is that of the minority worker arriving the workplace full of enthusiasm about his or her role only to be ‘knocked back’ by a general attitude that says: “we hired you, but please keep away from us”. Efforts directed at mutual friendship and acceptance is rebuffed; suggestions are ignored; assertiveness seen as aggression; politeness construed as laziness and critical thinking seen as obstinacy.

When white employees fail to acknowledge minority colleagues because they assume an air of superiority or that their way is the only way, the collective value of individual contributions is greatly diminished. In such an environment, employees become either passively uncritical; mere survivors or just conformist rather than effective, critically involved human beings. (Figure 2).

The minority worker from my experience and research has the motto: ‘live and let’s live’. He or she seeks an environment that would challenge them to their maximum capability and to attain a higher level of personal achievement based on their God given talent. However, from figure 2, it is my opinion that the immediate need of minority employees is not physiological nor is the second level safety, but justice – fair play, trust and genuineness followed by recognition. The minority worker like mainstream whites also has a fundamental need for recognition, appreciation and acceptance of his or her contribution towards the attainment of company goals. Minorities have a need to be one of the boys or girls; a need to be involved and a higher need for challenge and achievement. When the minority worker feels that her words and actions go un-noticed, serious emotional problems is likely to ensue. Therefore, top management should also create working conditions and methods of operation and assessment where people regardless of colour, sexuality, race or gender can maximise their strengths. Hospital systems should stop the tendency of putting square pegs in round holes or focusing on overcoming people’s weaknesses rather than maximising their strengths. The focus must shift to personality-to-jobfit and personality-to-culture fit that would allow for integration rather than the continued segregation of workers by poor managerial policies.

Winning with diversity

Hospitals that really care about diversity can learn from the most successful coach in the NBA - Phil Jackson of LA Lakers. Mr. Jackson has become the most successful coach in the NBA not only because he has coached some of the best players in the NBA – Rick Fox, Michael Jordan, Shaquille O’Neal, Scottie Pippen, Kobe Bryant, and Dennis Rodman, but the fact that coach Jackson recognises that a winning team is not only built around superstars, but also with lesser talent- all working together for a common goal.

In fact, it is the coach’s and therefore management’s ultimate responsibility to integrate disparate elements of unequal abilities into a smoothly running unit, while overcoming obstacles such as hatred, jealously, resentment, un-equal pay, overblown egos, race and gender issues. Success in sport or business is all about managing and enhancing human relationships within a corporate culture that encourages constructive disagreement. Therefore, managers must put in place a code of conduct that ensures that everyone is treated with respect, dignity and honor; a prima donna mentality must not be allowed. Without respect and an open environment where people feel free to share thoughts and feelings, an organisation’s creative energy and ingenuity can wane and this is usually the case in cultures lacking in people integration.

How can a hospital system get the most out of its diverse workforce?

How can it ensure that these individuals interact effectively with each other? And what can a company do when races clash? Make no mistake, it’s a delicate balance, and one that requires in my opinion, moral leadership- the capacity to distinguish right from wrong and doing right; seeking the just, the honest, the good and right conduct. Moral leadership gives life to people and enhances the chance of diversity succeeding by treating everyone fairly, eliminating barriers to equal opportunity and emotionally connecting every employee to a common, meaningful purpose. Rethinking Diversity-Lessons from History

Lance Armstrong won the Tour de France as a member of the U S Postal Team; his team mates were not selected to be just like Lance Armstrong, but were chosen to complement Lance’s strengths. The result was a team composed of riders from Spain, Columbia, Norway, Czechoslovakia, Luxembourg and Belgium. The team’s security chief was a veteran Texas department of public safety officer. The lesson is supposedly obvious; when you seek the best for your organisation you will end up with a diverse team. However, it is suggested that organisations populated with people who think alike, look alike, with similar social and educational have severe disadvantages:

  • Tendency to recruit friends
  • Manufacture products for friends
  • Sell to friends
  • Advertise to friends
  • Market research with friends
  • Assume values and needs are the same for everyone.

Unfortunately, our friends make up only a small percentage of the marketplace. The global market place is made up of diverse customers who are no longer white guys. Thus customeracquisition strategies derived from whit male dominated environment just would not cut it any longer. For example, Golden Sachs the investment banking firm headlines some of its advertising with: “The great news is that great minds do not think alike”. The implication is that successful organisations, are not environments of conformity of opinions, but hold varying perspectives to global issues.

Workforce demographics

The change in the workforce demographics is another important factor that organisations must address. According to the U S department of labor statistics, the workforce will soon be dominated by women, senior citizens and minority ethnic groups.

Immigration will also be a major factor for a diverse workforce. The foreign-born share of the population has more than doubled between 1970 and 1997. In the past, most Americans emigrated from Europe; the majority of the working population now comes from Asia and Latin America (Hattiangadi 1997). This diverse group also brings with them issues of group differences and an increased emphasis on trainability. To be effective management must focus on what would determine the future –trends and demographic changes and forget about what has worked in the past. They have no choice but to better coordinate the make-up of their workforce.

Ultimately, management must redesign their approach to the selection process. Major change is required in the selection process- to select individuals to join the organisation or on to teams rather than into a specific job. Selecting someone on the basis of his or her knowledge of a specific word-processing program for example may appear to be short sighted. Consider the changes in jobs, technologies, and business directions, they all change rapidly and job requirements will also change. Alternatively, selecting someone who can become an important part of a growing company seems a smarter investment.

Globalisation of diversity- a set of Benefits

In the 21st century, an organisation that embraces a diverse workforce will attain benefits that could increase its business opportunities and their quest to maintain a competitive edge. This view is supported by Chapman (2002) who argued in his article “Discomforting route to diversity”, that increased diversity is not merely inevitable in the workplace; it is positively a beneficial change for the best. He eludes to the fact that if the population where most corporations serve is diversified, it makes good business sense that the company’s workforce be diversified to realise business benefits. For example, if a company opened a retail store in a Hispanic neighbuorhood it would be to their advantage to hire Hispanics from that community, but without the pigeonhole mentality. A major advantage is that the residents would be more receptive to buying store merchandise when they see someone they can relate to working there.

Likewise, Chapman suggests that another benefit of having a diverse workforce that resembles the community in which it operates is the issue of harmony as it relates to social responsibility. How can this be one might ask? It is often said that an unhappy worker is an unproductive worker. Many workers are affected by what is happening at home, be it childcare or elderly care for parents. Most companies, when putting policies in place, rarely think about how it will affect the different cultures that make up their workforce and community. Given the diversity of the workforce that reflects the community, Chapman suggests that it forces firms to rethink their personnel policies from recruitment, to flexible work practices, to medical coverage that reflects differing family structure (Chapman 2002).

Also, by employing a diverse group of employees allows an organisation to identify talent from different backgrounds and widen the spectrum of knowledge available to the organisation. An article; A Strong Prejudice in the Economist Magazine (2002) suggests that diversity can boost creativity. For example in a research that included an ethnic and homogeneous group of people given the same problem. What they found was that the diverse group’s output was greater because they were able to draw from their different experiences (Economist 1995).

A final benefit of having a diversified workforce is that it allows you to enter untapped markets, those markets that have been closed due to language or cultural barriers. For example.

Avon realized that the influx of Asian immigrants created an untapped market. Avon started a campaign to recruit Asian American representatives that understood the culture and could

Communicate effectively with the target market (Economist 1995). The issue here is that the world is a global community requiring both a diverse product portfolio and workforce. Furthermore, as companies strive to expand their products globally, having a diverse workforce of different cultures affords the company insight specific cultures, economics and language, ultimately, saving the company time and money.

Sustaining workforce diversity

Sustaining workforce diversity in my opinion comprises four crucial components that companies should adhere to: commitment, monitoring, accountability, and celebrating milestones. Probably the most essential element in sustaining diversity in the workforce is commitment. Commitment to diversity must start with the CEO and trickle down to senior and the middle management. Management must be seen by the workforce to be an active participant in this process. Diversity must be one of the core values of the organisation. The senior management team must model the acceptable behavioural norm that says: ‘Our competitiveness and success is defined by our differences’. But the key is to let go of anyone however important who is accused of discrimination.

For example, many organisations sponsor cultural events for minority employees, but very seldom do CEO or anyone else from senior management attend. Management at all levels must attend these functions to sustain diversity within their company. Furthermore, management must promote involvement and commitment from everyone else within the organisation through training and conducting various activities that focus on diversity.

In addition, monitoring is another vital component in sustaining workforce diversity through conducting periodic analysis to recognise areas for improvement. Another vital component of sustaining workforce diversity is holding management and employees accountable. Executives, managers and supervisors must be held accountable for achieving results. This I believe can be achieved by determining a manager’s bonus on how they promote diversity through mentoring and developing minorities within their department. Also, senior management bonuses and incentives should be based on the success of the development programs implemented and their participation in diversity events within the company.

Finally, celebrating milestones or success of diversity programs is important in sustaining workforce diversity. For instance, awards should be given to employees or members of the management team recognising their accomplishments. Such as, a yearly awards program recognising a manager that have exemplified leadership in ensuring that diversity is demonstrated not only in his department but throughout the company. Also, through celebrating each success on an individual basis could prove to be a motivating factor for others.

Conclusion

The commitment to ensuring diversity throughout the organisation must start with the CEO and senior management. However, the Human Resources Department must be an active participant in this process. Celebrating the milestones or successes of diversity programmes is the key to sustaining workforce diversity. In order to identify high potential employees and replace key executive talent, HR management must first identify the companies’ future goals and challenges. Once this is established then HR can specify the skills, knowledge and characteristics needed in the potential candidates. Corporations retain high potential and fast track employees through profitability forecasts. These are decisions made by managers regarding the advancement potential of their subordinates. These high caliber employees are highly motivated and often elect to participate in mentoring programs, employee networking groups and organisational task groups. All of these programs are important to Corporations because they emphasise the importance of its most valuable resource: their employees.

--Issue 49--

Author Bio

Uche Nwabueze

Uche Nwabueze is a Professor of Maritime Administration at Texas A&M University, Galveston Campus, Texas, USA. Dr. Nwabueze’s research focuses on Healthcare process improvement strategies. Dr. Uche as he is fondly called by his students has served as faculty member across four continents.

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